Provider Demographics
NPI:1528228715
Name:GRACEFUL CARE SERVICE
Entity Type:Organization
Organization Name:GRACEFUL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEZENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-0349
Mailing Address - Street 1:1019 CAZO RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-6361
Mailing Address - Country:US
Mailing Address - Phone:337-363-0349
Mailing Address - Fax:337-363-0487
Practice Address - Street 1:1019 CAZO RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-6361
Practice Address - Country:US
Practice Address - Phone:337-363-0349
Practice Address - Fax:337-363-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15052310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility